Annular Ligament Issues-Advice Please

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MizzPurpleKitten

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Firstly, I rarely post on here but I really need some advice from others who may have some ideas, so apologies for the low post count etc, I assure you I am no troll.

Anyway, my little lad, whom I've owned since I was 11 years old was a little lame during the late stages of Summer this year, took him for a work up and it turned out to be due to thickening of the Annular Ligament in his Left Hind. He had ALD (Annular Ligament Desmotomy) surgery on the 1st Sep this year and has not really come right as of yet.

First, he got a minor infection in the joint, was flushed and all was well. He began walking exercise (in hand first then ridden) and started to do very well indeed (Vet even commented that he was the soundest horse he'd ever seen so soon post-op)

Then he had some adhesions forming and a large build up of fluid so he needed a cortisone injection into the leg, 2 days later he was back to ridden work and again, Vet was very pleased with him.

Now, 3 weeks since the injection, he can no longer bear weight on the leg and the leg has swollen to twice normal size. I have been given the option of another cortisone injection, but the vet has advised that the long term prognosis is not good as these injections should last at least 6 months and not a matter of 3 weeks at a time. I know my insurance will not cover another operation but I also do not know how viable an option this may be.

Basically I need some advice, does anyone know of any other options that I may not have explored as of yet? Has anyone tried turning away after this operation for a period of time with any success?
 
When my mare did hers

we just box rested her cold ice packs , cool gels and rest , cold hosing . No injections she took a few months to come right but she did.

What does your vets say. Is he in stable or turned out ?


Personally I find with any muscular or ligament injury its rest rest rest.

After all its what a dock says if you damage ligaments.:)
 
He is stabled overnight but turned out all day in a paddock with his friend (my other horse). He never runs round or anyhthing (very much a lazy lad lol). Vet has said that he needs to keep moving and the more exercise the better but I'm beginning to think this may well not be the case as his problems (except the joint infection) all happened since he's been back in work.

First he started to go lame the day after he'd been trotted (every time), the vet said this was completely normal as the trotting was tearing the adhesions which is what we wanted to happen and thus to continue. Now he has become unable to bear any weight on it after 1 week of being back in full work.

I Know he's worse when box restewd as he literally doesn;t move so he seizes up something chronic but I'm beginning to think that 'work' is doing him more harm than good and I suppose I'm hoping for some experiences either side of the coin so I can see if anyone has any other ideas it may e worth suggesting to my vet.

Thankyou for your reply, I appreciate any input :-)
 
When my boy did his we treated it with DMSO and rest. He was turned out but not ridden. He came sound and continued to hunt. In later years the problem was that there were nodules on the ligament which would "catch" and make him trip. If I put him on bute and rode him every day he was Ok I could then take him off the bute, he was fine and we continued to hunt. This year the tripping is really bad and he has almost come down with me a few times. He is totally sound though. Having said that he is 19 now. He also did his hind one too. He is about 17.2 Percheron Cross.
 
DitchJumper - Forgive my ignorance but DMSO? Also, thankyou for your reply, my boy is nearly 18 now and only had his op this year so he's not a spring chicken but likewise not exactly 'over the hill'. He too trips like mad but he always has done, I never thought it could be related but it may well be, and certainly something I will ask my vet to look into. How long a rest period did you give your boy?
 
A liquid which is absorbed into the skin. You have to wear gloves to apply it. Applied it to both damaged fetlocks. Needs doing straight away. Only did it for a week. Then we just left him out...if you could see his joint it is huge....but once it had settled down he was sound although the size did not go down much. When I could ride him every day was fine, but now Iam back at work full time I can't. In his life he has had ring bone, side bone and damaged check ligaments but just keeps going. Doesn't look or act his age.
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Ditchjumper2 said:
A liquid which is absorbed into the skin. You have to wear gloves to apply it. Applied it to both damaged fetlocks. Needs doing straight away. Only did it for a week. Then we just left him out...if you could see his joint it is huge....but once it had settled down he was sound although the size did not go down much. When I could ride him every day was fine, but now Iam back at work full time I can't. In his life he has had ring bone, side bone and damaged check ligaments but just keeps going. Doesn't look or act his age.
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hmm be careful if this is copy right or TFC will get you to remove it .

DMSO is also used for splints
 
Thankyou again Leviathan, from a logical point of view I totally agree with you, as surely with movement he is at a far higher risk of not healing properly (this is my thought on it anyway). I have considered getting a second opinion but sadly I'm stuck in a catch 22 as firstly, I have already paid my excess and the treatment is all going through the insurance at this stage.....I'm not sure how it would work getting a second opinion on that front. I am also worried about doing this as, to my knowledge there are only 3 veterninary practices who cover our area, the other 2 have both badly misdiagnosed my own horses and others on the yard, some to the point they had to be PTS due to not receiving the treatment they needed in time because of said mis-diagnosis, the vet I use has so far been spot on and comes highly reccommended by anyone who has ever used him.
 
I have been following this thread with interest as I know someone who has recently has her horse diagnosed with this problem. She will not operate (he is too old and does not do box rest anyway) but thought it might be worth a try for her.

Have been having a google for DMSO - is it a prescription medicine? If not where is the best place to get it from?
 
I think what your vet has told you is correct, but I would be seeking further investigation as it either sounds as though the operation wasn't successful or something else is going on im afraid!

My boy was diagnosed with a Palmar (front leg) Annular Ligament lesion when he suddenly went lame in October 2010: he was initially treated with Tensolvet and field rest, which didn't do much and then started Shock Wave Treatment (3 sessions, 2 weeks apart) with field rest following that... my vet advised it was key to keep the ligament moving!

All went well and he came sound. We then were hit with snow and due to the lack of excersise, my boy who has EMS, but was being managed with diet and excersise, got low grade laminitis.

This meant that I had to rest him and he started Metformin.

Once he'd recovered from this, the vet revisited and he was still lame, so he referred him to Liphook! The surgeon advised that due to the lack of movement during his enforced box rest, the lesion he had, had turned fiborous and surgery was his best option!

He decided to operate on both legs as the other leg showed thickening of the ligament as well.

He had his operation - he had full surgery on the original leg with the lesion (there was quite a bit of interest in it and loads of photos were taken, then the fiborous lesion was sent off to the lab) and key-hole on the other leg, and was home 4 days later. Whilst he had his bandages on (2 weeks) I was allowed to walk him in had to graze along the lane.

We then had 6 weeks boxrest with in-hand walking 20 mins twice per day. He was a monster and bucked and span and generally misbehaved, but we got through it! He then had 6 weeks restricted turnout (20 x 20 pen) and I started walking under saddle for 30 mins and had to build up to an hour and a half with 15 mins trot by the end. We got through it though without a days lameness and touch wood, since he was signed off on July 1st he has been fine!

I lunged him for the first time last week since (tto scared to before as I first noticed it on the lunge) and he was 100%.

I was told that the Annular Ligament is like a band which holds all the tendons in place, so when it gets thick, it presses on the tendons causing lameness and if left untreated, can damage the tendons themselves.

In surgery they cut the ligament, thus alleviating the pressure and the ligament then heals over again thinner... the point of maintaining excersise during all of this is that the new fibres will try and attach to anything - if they attach to the tendons they will restrict the range of movement. However, this excersise has to be restricted as until the ligament has healed sufficiently, the tendons are unsupported!

The surgeon told me that he has only ever seen unsuccessful cases when the underlying tendons were damaged or the horse had had an accident (i.e. got lose and galloped off down the road) post surgery and the tendons had become damaged.
 
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Thankyou for that.....I have to say I've known of 3 (4 if you include my boy) who have had problems post surgery within the first 2 years, all of which were re-operated on, however, I don't feel a re-operation is something I'd be willing to do as I don't feel the first operation was successful with the post-op issues he's had, plus another GA only a short period of time after the last is just asking for trouble IMO. Prior to the operation he was undoubtedly lame but he was about 3/10 and only in trot, since the op he has been between 8 and 9/10 lame in walk and trot at times and yet some times completely sound.

He's been scanned and shown no damage to the tendon or tendon sheath at all, and had open surgery as the ligament was the thickest the vets had ever seen apparently so they couldn't get in to do it keyhole, so I just don't know what's going on.

I know he's had adhesions form (these showed on the scan 4 weeks ago) which were treated with a cortisone injection however 4 weeks after the injection he's 8-9/10 lame again after following vets advice to the letter.

I'm just beside myself at the moment as I really have no idea what to do, he has only been in light work for the past few years really then was brought into full work in the summer, in August the problems started and the ligament issues came to light (the thickening and the tear), the op was on 1st Sep and since then he just hasn't been 'right'. He was box rested for around 8 weeks, then was paddock rseted (he hardly moves to be fair, real lazy lad) for a further 2 weeks then began ridden work. Ever since the ridden work he's been really up and down, one day sound the next 8-9/10 lame, the next sound etc etc until re-injuring the ligament (we assume anyway due to the swelling and the serious lameness, he is unable to weight bear on the leg at all!) 2 days ago, now he's unable to weight bear and I have been told that the only available option would be to continually inject with cortisone......I just don't know whether this option is viable and am hoping for some other ideas if any as, considering the first injection has only given him relief for 4 weeks (and it's a very painful not to mention expensive injection) is it really any quality of life?

Just as an aside, I am waiting for the vet currently, and I called them immediately when he showed such obvious signs of pain, so I'm not only relying on opinions here. Just in case anyone thought I was being dstupid and not getting the vet back.
 
I guess I must be lucky then. No damage to tendons at all but a HUGE fetlock. Doesn't bother me what he looks like. My vet, for most conditions, believes movement is key as box rest can cause other issues. However, you have to be guided by your own vet.

I got the DMSO from my vet.
 
Hi, my retired horse had the annular ligament cut through on the hind leg, but within a couple of days of the op she began resting her leg, it has always been the other leg before.
The vets told me the op was a success, but she was never completely sound on it, and the area around it became very swollen and fibrous.
I followed the rehab to the letter, had a steroid injection to try to help the area, but she always stayed a few tenths lame on it. The vets told me to continue with the rehab, but then 3 months into it, she spooked, and went lame on the leg again.
It was rescanned and it was found she had done a tendon, in the area, so that was that, she was retired.
The vets would still say the op was a success, but I wouldnt agree, as she looked wrong within a couple of days of the op and never really improved, and yes this was done by a highly regarded equine hospital.... :(
 
Just a little update,

My vet has been out to see him and re-scan, turns out he's now managed to damage the DDFT and the SFT in that leg (but the annular ligament is healing really well!). 2 weeks box rest with in hand walking as a compromise so the ligament doesnt start to become fibrous again then another re-scan.
 
i had to get my DMSO through ebay via Ireland! It's not made in the UK anymore but some vets still have stockpiles of it. unfortunately it blistered my horse's white legs so had to stop. he had course of Cartrophen and shockwave treatment for his bilateral hindlimb annular ligament desmitis but nothing worked. he was kept on pen rest as vet advised best to keep him moving but he was getting worse so he had the op. he did well for 6mths then came in hopping lame again. vet said v unusual for them to reinjure them post-op, offered surgery again but at the age of 21 and with no insurance had to say no. he had 2yrs off then came back into light work and last yr he was back on the veteran show circuit 100% sound. this yr he got chased by a dog downhill out hacking and reinjured it and hasn't been quite 100% sound since although he is now back to hacking out after some more months of rest. he is 25 now and still hoons round the field like a loony!
 
star said:
i had to get my DMSO through ebay via Ireland!

this yr he got chased by a dog downhill out hacking and reinjured it and hasn't been quite 100% sound since although he is now back to hacking out after some more months of rest.
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Sorry to hear he re-injured it, how annoying.

Hope you don't mind me asking but is there a particular strength you bought and did you use a preferred seller?
 
Star, just noticed your mention of cartrophen. Now I know you said nothing compltely worked so you opted for surgery but did you feel the cartrophen made any difference at all? I only ask as I've used cartrophen with my older slightly arthritic gelding and it brought him back to 100% soundness to the point where he is back in hard work and regularly competed, so, if it might help my little lad I'd be more than wiling to give it a shot :-)

Also, whoever said it's bad news that is actually good news, yes, I feel that way. It's bad news that he's actually done himself some damage but good news that we now know what we're dealing with and have a treatment plan in place to (hopefully) get him better again soon :-)
 
he got worse in the time frame that he had rest, cartrophen and shockwave so I dont think the cartrophen did anything and TBH I didn't expect it to as it's not really a ligament treatment but vet suggested it and insurance paid for it.
 
Tht's kind of the answer I was expecting Star, but I thought it was worth asking just in case :-)

Thankyou everyone for your experiences and advice, it' certainly given me food for thought etc, fingers firmly crossed that my lad recovers enough to comfortably be retired to a field if nothing else.
 
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